Cecal bascule in a child: an unusual cause of postoperative bowel obstruction.

Cecal bascule is a rare type of intestinal obstruction that occurs when a mobile cecum folds upward and obstructs the ascending colon. Most often occurring in the elderly, we present the first reported case of cecal bascule in a child. The cecal bascule occurred in a 4-year-old with trisomy 13 syndrome 5 days after a laparoscopic Nissen fundoplication. After a delay in diagnosis and cecal reduction in the operating room, the bascule recurred after 1 year, and the child was treated with a cecostomy tube for both cecopexy and cecal decompression. Cecal bascule should be considered in the differential diagnosis of children with early postoperative bowel obstruction, especially in the developmentally delayed status-post laparoscopic surgery. For the pediatric patient with cecal bascule, we recommend operative management with either cecopexy or resection.

MRI for the evaluation of pectus excavatum.

Pectus excavatum, the most common congenital deformity of the anterior chest wall, is both a cosmetic and functional abnormality. The degree of abnormal chest wall deformity determines its functional effect, particularly its cardiac and pulmonary impact. Although CT scanning is the most widely used cross-sectional imaging technique used to measure the Haller index, the radiation exposure is reason to seek other alternatives. At our institution, we have introduced a rapid MRI technique for this purpose, which utilizes a single-axial 2-D FIESTA acquisition.

Renal and testis injuries in team sports.

PURPOSE: Children with a solitary testis or kidney are generally advised against contact team sport participation to protect the solitary organ. We performed a review of renal and testis injury cases to ascertain if there was an increased likelihood of significant renal or testis injury in team sports. MATERIALS AND METHODS: We retrospectively reviewed charts on patients evaluated and/or admitted to the trauma service with renal or testis injuries. Severity, outcome and external cause of injury were evaluated as well as patient demographics. Patients were excluded from study if there was no radiographic or physical (postmortem or surgical) evidence of injury. Trauma admission/registry data from all patients enrolled were used for comparison. RESULTS: Of 14,763 patients enrolled in the trauma registry from July 1984 until December 2000, 450 (3%) were given a renal or testis injury diagnosis by the registry but only 209 patients (1.4%) met the review criteria for documentation of injury. There were 193 renal injuries (92.3%) and 16 testis injuries (7.7%). A total of 113 injuries were sustained during a recreational or team sport activity (54.1%) and only 10 renal (6) or testis (4) injuries recorded were sustained in team sports (4.8%). Overall team sports injuries recorded in the trauma registry for the study period was 3.4%. No team sports injured patient had a solitary testis or kidney and 1 patient had congenital ureteropelvic junction obstruction. There were only 3 associated injuries (spleen 2, skeletal 1) in the 10 patients. Surgical exploration was performed in all 4 testis injury cases, acute repair of renal injury was done in 1 and delayed pyeloplasty was performed for congenital ureteropelvic junction obstruction. No organs were lost and all patients recovered uneventfully. CONCLUSIONS: Renal and testis injuries occur with team sports, although at a much lower rate than from other external causes of injury. Most patients ultimately do well without loss of the injured organ. Recommendations against team sport participation may not be necessary in patients with a solitary kidney or testis.

Congenital urinary tract anomalies in pediatric renal trauma patients.

PURPOSE: Congenital genitourinary tract anomalies occur commonly in the general population. Anomalous kidneys are thought to be more frequently injured by trauma than normal kidneys. We reviewed patients with renal injuries to determine the etiology, severity, associated injuries and associated congenital genitourinary abnormalities. MATERIALS AND METHODS: A retrospective review of renal injuries was performed on patients evaluated and/or admitted to the trauma service. Severity, outcome, external cause of injury and patient demographics were evaluated. Patients were excluded from study if there was no radiographic or physical (postmortem or surgical) evidence of injury. Findings on urinalysis alone did not confirm a renal injury without other evidence. Trauma registry data from all enrolled patients were used for comparison. RESULTS: A total of 14,763 patients were enrolled in the trauma registry from July 1984 to December 2000, of whom 384 (2.6%) were given a diagnosis of renal injury but only 193 (1.3%) with radiographic or other physical evidence of renal injury were included in this review. Of the 16 renal injury patients (8.3%) 15 boys (93.8%) and 1 girl (6.2%) had congenital genitourinary abnormalities. Of the 193 patients 136 boys (70.5%) and 57 girls (29.5%) sustained renal injuries. A total of 20 patients (10.4%) died of injuries but none had a genitourinary anomaly. The genitourinary anomaly group had 6, and the entire renal injury group had 298 associated injuries. Only 6 patients with congenital genitourinary anomalies required surgical procedures primarily for elective repair of ureteropelvic junction obstruction. The most common external sources of injury, primarily falls, recreational or motor vehicle accidents, were similar for all patients, all renal injury patients and those renal injury patients with congenital genitourinary abnormalities. CONCLUSIONS: Renal injuries occur in about 1.3% of trauma patients (193 of 14,763) and 8.3% of the renal injury patients had congenital abnormalities (16 of 193). Most injuries occurred with falls or recreational activities. This population is small but the injuries were nonlife threatening and renal salvage was likely with or without surgery. Congenital genitourinary anomalies may not increase risk of morbidity.

Lower genitourinary injury and pelvic fractures in pediatric patients.

OBJECTIVES: To report the largest series of pelvic fracture and lower genitourinary tract injury in the pediatric population to further define its incidence. The association between pelvic fractures and lower genitourinary tract injury has been well recognized in the adult population. The incidence of bladder or urethral injury is approximately 10% to 15%. Previous limited pediatric reviews placed its incidence at slightly lower levels. METHODS: A retrospective review of 8021 trauma patients presenting between July 1992 and March 1999 to a pediatric trauma center included 212 consecutive patients with pelvic fractures. These records were reviewed to determine the incidence of genitourinary injury in children with pelvic fractures. Thirty-six patients were identified with a genitourinary injury, and their records were analyzed.Results. Thirty-six patients (17%) were identified to have sustained a genitourinary injury out of the study cohort of 212 patients with pelvic fractures when patients with isolated hematuria were included. Hematuria was noted in 30 patients (14.2%). Fourteen (6.6%) had gross hematuria. Only 2 (0.9%) of the 212 patients had a significant lower urinary tract injury (one extraperitoneal bladder rupture and one posterior urethral disruption); both had gross hematuria. Genital injuries were seen in 4 other patients (1.9%). Lower genitourinary injury occurred in a total of 6 (2.8%) of the 212 patients with pelvic fractures. CONCLUSIONS: The incidence of significant lower genitourinary injury in pediatric patients with pelvic fractures is lower than that reported in previous adult and pediatric reviews. Significant lower genitourinary injuries were not found in stable patients without gross hematuria or multiple associated injuries and with a normal genitourinary examination.